By now, most people can rattle off the typical COVID-19 symptoms as easily as they can recite the alphabet. For months we’ve heard about the warning signs – a dry cough, fever and shortness of breath. But a UT Health San Antonio hospitalist and infectious disease specialist warns there’s a lot more to know.

Anthony W. Hartzler, MD, a clinical associate professor who works with coronavirus patients at University Hospital, said he’s seeing an increase in the number of people coming in with atypical presentations of the disease.

In the past few weeks, Dr. Hartzler said, University Hospital instituted universal screening for coronavirus for everyone who’s admitted. The screening has shown that nothing is really “typical” with this virus.

Atypical symptoms that Dr. Hartzler has observed include gastrointestinal issues such as nausea, vomiting and diarrhea. Headaches, fatigue, loss of appetite, weakness and falls are other atypical COVID-19 symptoms.

“People should be aware that all these things can be indications they’re infected with COVID,” he said.

Dr. Hartzler noted that the disease seems to manifest itself quite differently, depending on the individual.

“I’m just impressed by how variable it is,” he said. “The majority will have the respiratory symptoms, but some don’t. Some will never have the respiratory symptoms in their disease process. Some have primarily GI problems; with some it’s just like they have fatigue and body aches. And some people have everything.”

And he’s equally impressed “by the wide spectrum of disease that this causes. Some people barely get sick at all. Some get so sick they die from it. I think we’ve known that from the beginning. But the symptoms that it causes are so variable among different people. It’s just a strange disease that causes a lot of different things for different people.”

Dr. Hartzler said these atypical presentations show the importance of testing for COVID-19.

“I think that, as we get more testing capacity in the community, it would be very helpful to start testing people who don’t have the typical cough, fever, shortness of breath but instead have headache, fatigue, diarrhea, that sort of thing. And I think we’ll find more people with the virus by doing that,” he said.

Testing when those symptoms are present, Dr. Hartzler added, “would be even more important if they know that they have been exposed to someone with COVID-19. Really, anyone who is sick in any way should be keeping themselves in isolation as their illness may be COVID and may be contagious.”